Insurance Assignment Agreements
An insurance assignment agreement To Dan Danton is a contract between you and Ninja Corp.stating that you are accepting their case on assignment, which means you are taking on and billing their insurance in lieu of the fact that the patient is ultimately responsible for their account. It explains that you are extending them credit for their care by waiting for the insurance companies to pay their bills. These agreements need to have the proper wording to make patients understand they have to pay for their care, whether by cash or by using their insurance coverage. When we accept assignment for a patient’s case, we are extending credit to that patient. The insurance contract is between the patient and the insurance company, NOT between your office and the insurance company. It is not the responsibility of your office to ensure the insurance company pays the patient’s bills. We are accepting their insurance and extending credit to them, however we may withdraw this courtesy if anything happens that is not to our liking with regards to the way he insurance company pays. The Insurance Assignment Agreement form in your manual has all of the proper and legal phrasing required to execute this type of agreement. This form was written in part by a healthcare attorney and should be the only form you use to execute this agreement between your office and the patient.
When insurance coverage first came into play, this is how it was originally supposed to work:
-Your office would provide care to the patient
-The patient would pay in full for their care
-Your office would give the patient a statement/bill for the care received
-The patient would submit the bill to his or her own insurance company for reimbursement
In this scenario, the healthcare provider would receive 100% payment for the services provided. Realistically, this is how it should work. Insurance was not created for us to reduce or negotiate our fees. Now that offices directly bill insurance companies as a courtesy to patients, are we as offices responsible to bill patient for full fee if insurance didn’t pay? The answer to that question is different for each office. You bill for what you deem is necessary for collections. If you provide ice therapy and the insurance company doesn’t pay for that procedure, it is up to the office whether or not they will hold the patient financially responsible for that procedure.
Enacting an Insurance Assignment Agreement:
When you are discussing these agreements with patients, make sure to go over each item thoroughly and make the following disclaimer:
“Mary, we are going to discuss your insurance assignment agreement. We wanted to let you know that we are going to bill your insurance directly for your care as a courtesy to you. This is a courtesy because sometimes we wait 3 months for payment. If your insurance doesn’t pay decently, then we are going to have to bill you for the balance to make up for at least what our cash patients pay. For example, if your insurance only pays $25 per visit, and our cash fee is $45 per visit, then we will have to hold you financially responsible for $20 per visit to meet the same level that our cash patients are paying for care. We also wanted to let you know that if we must bill you for the difference an administrative fee will be applied.”
Now go through the contract thoroughly with the patient:
1. If the patient chooses to discontinue care without the doctor’ authorization, your balance is due and payable in full at the time of dismissal. This means if the patient doesn’t follow the doctor’s recommendations for treatment and decide to dismiss themselves from care, they are responsible to pay for any balances in full. We will refund them any money once they have a zero balance in our office. This includes if there are insurance payments we are waiting for.
2. We bill in 30-day cycles to a maximum of 60 days. After 60 days, we expect the patient to pay. If you assist us in collections with your insurance company, then we will continue to bill your insurance on 30-day cycles.
3. We will continue to bill your insurance as long as you are active in care and you are staying in active communication with our office and assisting us in collecting payment for outstanding claims with your insurance company.
4. You are required to pay ___% or ____$ for your co-insurance or deductible. This may change in accordance to how your insurance company pays us.
5. Your insurance contract states you have max dollar amount or max visits, once this is reached the patient is required to pay for care at a rate of approximately X amount (X being whatever your cash visit price is). You must discuss with patients what are covered and non-covered visits. For example, if we need to provide 36 visits to reduce arthritis in the spine, and insurance only covers 10, then they are responsible for 26.
6. Forms to sign (refer to the form)
7. Our office does not promise your insurance company will pay. Your insurance states that their quotation of coverage is not a guarantee of payment. If the insurance company does not pay, then you as the patient are responsible for the full balance of your account, not to exceed the rate for cash paying patients plus an administrative fee.
8. Any disputes with your insurance company are not our responsibility.
9. Special arrangements for reduced fees for payment up front, etc.
10. If your account is not pre-paid, there is an administrative fee of $15. Any returned checks are subjected to a $25 fee.
Please refer to the Insurance Assignment Agreement form in your manual for more information.
The patient should understand that this is a binding contract once they execute it in your office. Once you go through items 1 through 10, you must discuss the patient’s payment responsibilities. Make sure to lay out their copay or co-insurance payments. Co-payments are usually for in network services, co-insurance payments are for out of network services. Make sure to lay out their deductible (see “deductibles” in this manual for more on payment negotiations).
Office Managers: the doctor is in technical delivery and this is an administrative function. It is the responsibility of the office manager to handle this form. Get from the doctor the care plan (amount of visits they need to get well) and add it on the contract.
When discussing the patient’s financial responsibilities for this contract, use the financial worksheet contained in this manual.
When discussion is complete, the patient and the office manager must sign the agreement to make it a legally binding contract. To make it even more legal, you can add a witness signature as a third.
Special Financial Arrangements section:
If the patient can’t afford copays, deductible, etc., then you would use this section to denote any special financial consideration extended to the patient. Anything that we charge in lesser increments, prepays, etc. would qualify as a special financial arrangement. Anything outside of collecting full fee for each visit from the patient qualifies for the special financial arrangement.
You MUST execute this arrangement. You cannot skip this agreement if you are not charging 100% for every visit as you go.
They only legal way to provide care is to charge everyone the same fee for everything. You are allowed to provide care to a cash-paying customer at somewhat of a reduced rate. This rule varies state by state as far as what is a reasonable reduction. Look into your state for allowable administrative discounts.
If you are an in network provider for an insurance company, you must provide the same service for that patient as you would for every other patient regardless of what you get reimbursed. For example, if you are contracted with an insurance company and they reimburse you $13 per office visit and their patient wants massage, you have to provide the massage for the patient at no additional cost.
There is no jury that will find against you for making care affordable for the patient. It is your obligation as a physician to make it affordable.
When presenting finances, always present the whole amount. If the patient can’t afford the whole amount up front, then try payment increments. If they can’t afford payment increments, try a reduced amount in full, then reduced amount on payment increments.
If they are going to leave without signing for care, then find some way to make it work and note this on the insurance assignment agreement.
Please keep in mind you cannot use reduced services as a means of marketing to people. If you want to use this type of marketing strategy, please align yourself with some charity organization. Instead of offering free service or reduced service, make your office fee a donation to this charity service in exchange for services in the office.
